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2. Contact Information
4. Applicant’s Name:*
5. Company/Organization:
7. Mailing Address:*
9. Phone (Day):*
10. Phone (Night):*
12. Phone (Cell):*
13. Fax:
15. Email:*
17. Event Information
19. Event Name:*
20. Event Date(s):*
    Event Date(s):
22. Set Up Date/Time:*
    Set Up Date/Time:

    Set Up Date/Time:
23. Take Down Date/Time:*
    Take Down Date/Time:

    Take Down Date/Time:
25. Event Location:*
27. Total Estimated to Attend:*
29. Purpose/Description of Event:*
31. Parking Plans (Please note ALL proposed street closures; include locations, dimensions, capacity of spaces to be available & layout sketch):*
33. File Upload

    Please upload any materials, maps, or plans.

35. Upload
36. Upload
37. Upload
38. Upload
40. On-Site Contact Person:*
42. Phone (Day):*
43. Phone (Night):*
45. Phone (Cell):*
46. Fax:
48. Email:*
50. Insurance Requirement

    If required provide proof of commercial general liability insurance in the amount of $1,000,000 per occurrence, and naming the City of Washougal as an additional insured. (Washougal Municipal Code 9.104.140) HOLD HARMLESS STIPULATION: Permit tee covenants and agrees to indemnify, defend and hold harmless the City, its officers, agents and employees from and against any and all claims, damages, liability, cost and expense, including reasonable attorney’s fees in connection with or occasioned, in whole or in part by any act or omission of Permit tee, its officers, agents, employees, customers, or licenses, or arising from or out of Permit tee’s failure to comply with any provision of this Permit, regardless of whether it is alleged or proven that the acts or omissions of the City, its officers, agents, employees caused or contributed thereto. 

    All parties mutually agreed upon this waiver. This indemnity shall not apply in the event any acts or omissions of the City were the sole cause of any such damage or injury. To the extent any of the damages referenced herein were caused by or resulted from the concurrent negligence of the City, its officers, agents, employees and the Permit tee, its officers, agents, employees, this obligation to indemnify, defend and hold harmless is valid an enforceable only to the extent of the negligence of the Permit tee, its officers, agents, employees.

    
    

52. Electronic Signature*
53. Date:*
    Date:
55. PLEASE NOTE:

    This application may be denied if the proposed activity disrupts traffic beyond practical solution; interferes with access to fire stations and hydrants; causes undue hardship to surrounding residents or businesses; requires the division of so many public employees that services are denied to the public at large; or fails to fall within City Standards. The permit may also be rescinded at any time if complete and accurate information was not provided on the application; if the event is not held within the terms of the permit, or if there is failure to comply with applicable legal requirements.

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57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field